| NPI | 1932721727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist, School (Licence: ID 565845168) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: WA 509922A) |
| 103TS0200X Psychologist, School (Licence: CA 200084934) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-05-14 |